Provider Demographics
NPI:1962836213
Name:SMITH, CARLA JEAN (APN)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VIRGINIA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7331
Mailing Address - Country:US
Mailing Address - Phone:870-698-4826
Mailing Address - Fax:870-793-2627
Practice Address - Street 1:501 VIRGINIA DR
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7331
Practice Address - Country:US
Practice Address - Phone:870-698-4826
Practice Address - Fax:870-793-2627
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003948363LF0000X, 363LG0600X, 363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health